Routine inspection·March 26, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents which one can be bedridden. Facility has an approved hospice waiver for 2 residents and the home currently has 4 residents, with 2 residents on hospice. Administrator (AD) Larry Lindsey arrived shortly after. AD has a valid certificate that expires on 12/25/2025. LPA along with Staff 2 (S2) toured the facility at 1:23 PM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 4 resident bedrooms, 2 living rooms, dining room, staff room, and kitchen as well as 3 resident bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 1:25pm, LPA observed 6 out of 6 stove burners were non operational without an external lighter. At 1:31pm, LPA observed 2 gallons of emergency water. At 1:33pm, LPA observed a utility knife in an unlocked drawer in the living room next to the kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured 105 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. At 2:05pm, LPA observed 4 out of 4 auditory exit alarms non-operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 3/1/2025. Outside grounds were toured. Continued on LIC809C dated 3/26/2025 Walkways around the home were clear of hazards. Exit gates are unlocked and operational. There is shaded outdoor seating for residents. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. LPA observed the emergency food supply. LPA reviewed four resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. At 3:45pm, during medication record review by LPA, no PRN record keeping was observed. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.